Grabenstetter Anne, Brennan Sandra B, Jochelson Maxine S, Brogi Edi, Morrow Monica, Tan Lee K, D'Alfonso Timothy M
Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Histopathology. 2024 Sep;85(3):397-404. doi: 10.1111/his.15233. Epub 2024 Jun 6.
Radial sclerosing lesions (RSLs) are benign breast lesions composed of glandular and epithelial proliferations with stellate architecture and fibro-elastotic stroma, which can mimic invasive carcinoma on imaging. Surgical management following a core biopsy diagnosis of RSLs remains controversial.
We retrospectively identified core biopsies with RSLs without atypia who underwent subsequent surgical excision between 2015 and 2021. All core biopsy slides were reviewed to confirm the diagnosis. Imaging was reviewed to determine radiological-pathological concordance. An upgrade was defined as invasive carcinoma or ductal carcinoma in situ (DCIS) in the excision. The final cohort consisted of 130 core biopsies from 124 women (median age = 52 years, range = 27-76). The imaging modality was mammogram in 52 (40%) cases, MRI in 52 (40%) and ultrasound in 26 (20%). One hundred and seven (82%) core biopsies were vacuum-assisted and 23 (18%) were ultrasound-guided without vacuum assistance. The median lesion size on imaging was 9 mm (range = 2-41). Overall, two (1%) cases were upgraded at excision, including one microinvasive lobular carcinoma and one 2 mm focus of invasive mammary carcinoma with associated DCIS. In both cases, the upgraded foci of carcinoma were not closely associated with the biopsy site and were considered incidental upgrades.
This study adds to the body of literature supporting observation, rather than routine excision of radial sclerosing lesions without atypia.
放射状硬化性病变（RSLs）是由具有星状结构和纤维弹性基质的腺上皮增生构成的良性乳腺病变，在影像学上可酷似浸润性癌。经粗针活检诊断为RSLs后的手术处理仍存在争议。
我们回顾性纳入了2015年至2021年间接受后续手术切除的无非典型性的RSLs粗针活检病例。复查所有粗针活检切片以确认诊断。复查影像学检查以确定放射学-病理学一致性。升级定义为切除标本中为浸润性癌或原位导管癌（DCIS）。最终队列包括124名女性的130例粗针活检（中位年龄 = 52岁，范围 = 27 - 76岁）。52例（40%）的影像学检查方式为乳腺钼靶，52例（40%）为MRI，26例（20%）为超声。107例（82%）粗针活检为真空辅助，23例（18%）为无真空辅助的超声引导。影像学上病变的中位大小为9 mm（范围 = 2 - 41）。总体而言，2例（1%）在切除时升级，包括1例微浸润性小叶癌和1例伴有DCIS的2 mm浸润性乳腺癌灶。在这两例中，升级的癌灶与活检部位无密切关联，被认为是偶然升级。
本研究为支持对无非典型性的放射状硬化性病变进行观察而非常规切除的文献增添了内容。
